I don't know anything about Obamacare except that it's so complicated there's no point in an ordinary person trying to understand how it will all turn out. And evidently the people who try to understand Obamacare come to different conclusions about whether it will destroy civilization or simply help some people who need it.

But interestingly, I'll bet there will someday be an objective way to look back and say, "That worked," or "What the $#%@ were we thinking?"

For example, economists will someday calculate that Obamacare cost X number of jobs, or perhaps even created jobs, or it was a drag on GDP of X dollars, or perhaps helped GDP. And we'll know how many people got health care, especially preventive healthcare, that otherwise might not have. I think economists can calculate the economic value of preventive healthcare. In other words, I'm fairly sure that in ten years we can say Obamacare worked, overall, or it was a huge mistake.

So who is up for some side bets on Obamacare?

I'm sympathetic to the opinion that introducing a huge, complicated, government-run program is just asking for trouble. On the other hand, the Adams Rule of Slow-Moving Disasters says everything will work out.

As a reminder, The Adams Rule of Slow-Moving Disasters says that any disaster we see coming with plenty of advance notice gets fixed. We humans have a consistent tendency to underestimate our own resourcefulness. For example, the Year 2000 bug was a dud because we saw it coming and clever people rose to the challenge. In the seventies, we thought the world would run out of oil but instead the United States is heading toward energy independence thanks to new technology.

Obamacare is a classic slow-moving disaster. Absent any future human resourcefulness, it just might be a nightmare. But my money says that clever humans will figure out how to tame the beast before it triggers the collapse of civilization.

If betting were legal, I'd bet $10,000 that in ten years the consensus of economists will be that Obamacare had a lot of problems but that overall it was neutral or helpful to the economy. I base that hypothetical bet on The Adams Rule of Slow-Moving Disasters, not on the scary first-year state of the law. And I reiterate that I know next-to-nothing about the details of Obamacare. I'm just working off of pattern recognition.

The armchair economist in me thinks there is a solution to the problem of some folks thinking Obamacare will be a disaster and other people thinking it will not. Simply create an online market in which the opposers can buy "insurance" from the supporters. In other words, a hardcore Tea Partier could pay $1,000 now to insure against future Obamacare calamity to his own net worth. An Obamacare supporter would accept the $1,000 and put in escrow $10,000 as a payout in the event that Obamacare heads to the worst case scenario. This idea needs work, but the idea is that opposers and supporters could place insurance-like side bets.

Which way would you bet? And keep in mind that you know as little about Obamacare as I do.

Rank Up Rank Down Votes:  +36
  • Print
  • Share


Sort By:
Nov 7, 2013
Except in this case even though we see it coming, we disagree on whether it's a disaster, much less the best course of action.

Then we need legislation and regulation.

All of which moves more slowly than actuarial statistics.
Oct 29, 2013
I am a partisan in this fight and I withheld judgment because I am not an outsider looking in and judging the thing. I'm directly involved in the mess.

As I write this - it looks like a disaster.

But I also agree that slow moving disasters will find solutions when there is enough warning time that doom is impending. I really don't expect much of the ACA to survive. But something will evolve from that which will create new deadlines of crises. And something else will evolve for that.

So in the long term, your thoughts about slow moving disasters is right.

But I would also point out that many people suffer in the interim of change. And right now that reality is staring me starkly in the face. I oppose the ACA. I also think reform is necessary.

I think the failure of the ACA (and right now all of the news - including from left-leaning news organs - is pointing that way) will make it even harder in the future to make the kinds of reforms that are needed. Healthcare needs a solution - but the failure of this program is only going to make voters more cynical - and make that solution harder to achieve. I predict problems for a long time. The solutions will be non-optimal. The two parties in power will trade blame for healthcare not working.

And the only thing I can predict - as an M.D. - is this: I have twenty years left to practice.

And my guess is the government will be trading blame about healthcare for all of those twenty years - and I will suffer for it.

I am not a fan of me suffering. But I suspect that when enough physicians suffer - there will be labor unions. We are not the type of people to form labor unions. But as I see it - labor unions may be necessary to deal with the stupidity that is happening - and the reaction to the stupidity that is coming.

My advice to avoid all this is not to trust politicians - who are all lawyers - to play doctor. Doctors can fix this. But how many doctors are politicians? We're 1 person in 1,000 and there are very few doctors who have political power. We're too busy.

So when the politicians, who are not doctors, fix the problem - what we get is lawyers telling doctors how to behave. This is not why I worked my ass off in medical school. I did not work my ass off to serve lawyers.

And I suspect that most people who read your strip - who are people who know how to do things - can relate. They didn't become engineers to take orders from an MBA.
+9 Rank Up Rank Down
Oct 23, 2013
"If betting were legal, I'd bet $10,000 that in ten years the consensus of economists will be that Obamacare had a lot of problems but that overall it was neutral or helpful to the economy."

Coming from the totally socialist Netherlands, I'd say it's the wrong question to ask. The question is not if the economy is helped. The question is if healthcare has become more accessible. If yes, the secondary question is whether this is realized at acceptable costs. Healthcare never helps the economy. All capital and jobs created from it are the result of costs. The only value-adding type of healthcare is if you export healthcare goods to another country and profit from it.

All of this is assuming that healthcare up to a point is a right, and not a product on the free market. And that's my belief, feel free to disagree.

Or instead, whether you agree or don't, take a practical look at how almost every other developed nation in the world manages it far better.
Oct 23, 2013
I'd bet that in ten years, people will view it as a success, if only because it still exists, people are using it, and it'll be hard for most to envision what the alternative would be. I think most would rate Social Security, Medicare, and Medicaid the same way, right now.

Realistically, I think we'll be trading down the effectiveness and timeliness of our health care (against the trajectory it was on), in order to give a very small percentage of people access to it. We could have solved that issue in a much simpler fashion.

Inevitably, Obamacare will grow to become THE health care system. As we're already seeing, there will be problems. The solution will always be... the govt needs to take control of this other facet of health care in order to resolve that. Inexorably, the exchange will turn into govt-owned and managed health care.

When the debt crunch meets up against govt run retirement and health care systems, services will have to be cut. We'll all allow that. Again, we won't see the possible alternatives. It'll just have to be done. Austerity will be the hangover after the party, not a strategy to grow the economy. The sooner the party ends, the smaller the hangover.
Oct 23, 2013
[ It works in that it objectively delivers better outcomes for less than half the cost of the US system. What other possible way can you define 'works'? ]

Oh, well, certainly it works better than the US system. I would totally agree with that. But you aren't setting a very high bar for success there, are you?

I'm curious to hear how you define "better outcomes" so that you can measure them objectively. I've talked to many transplanted English folks here who, to a man, defended NHS' virtues. What was interesting, though, was that even while doing so, how they actually described it operating sounded terrible, comments like, "If the problem you have isn't life-threatening you can have to wait up to six months sometimes to have it addressed."

That is what caught my eye about the sentences I quoted: the cognitive dissonance of, Hey it's great, everybody loves it, but it has these massive problems that pretty much doom it to failure if they aren't fixed. Again, that's a classic description of a government-run program.
Oct 23, 2013
An interesting article if obviously from a very conservative perspective - for instance:
"But British reformers who want to see more market mechanisms within the NHS would see it as a huge step forward — relative to what they have now — if the U.K. were to move toward a system of subsidized compulsory health insurance along the lines of Obamacare."

This is clearly tautological. I don't think the number of such reformers is particularly high. The article focuses on cancer outcomes to avoid a negative comparison.

I would however accept there is truth in:
"The drawback of such an approach is that because the system prides itself on creating equity by putting the needs of society as whole ahead of any given patient, it means that the needs of individuals often get lost in a sea of managers, administrative targets and rationing decisions."

The NHS could benefit from a lot more focus on the person being treated.

Overall though what we do have is a system that will not let us get forgotten. This is of the utmost importance to most of us. Under no !$%*!$%*!$%*! will any of us be denied access to health care - there is no pre-existing condition nonsense and there are no profit-oriented insurance death panels.
+2 Rank Up Rank Down
Oct 22, 2013
In recent years the UK system has been besieged by a succession of major scandals, notably by the one at Stafford Hospital brought to light by Julie Bailey...

-4 Rank Up Rank Down
Oct 22, 2013
Just because over time citizens get worn out to the point of apathetic acceptance doesn't mean the system is a success. I love how people say that healthcare was broken, unsustainable, unfair, what have you, before, so at least Obama did something. That's a moron's logic. If you can even use logic when referring to such misguided thinking.
Oct 22, 2013
"No offense, but from these two sentences, NHS sounds like a classic government clusterf*ck. Sure, everybody loves it -- who doesn't love getting stuff for free? -- but that doesn't mean it *works*."

It works in that it objectively delivers better outcomes for less than half the cost of the US system. What other possible way can you define 'works'? It does have many problems - mainly being shafted because private suppliers are pretty successful at leeching e.g. charging £50 to change a lightbulb under enforced outsourcing.

That said I disagree with workerant that Obamacare is anything like the NHS, it seems more like a sticking plaster on a system that has lots of pre-existing conditions. You have a long long way to go to get near anything as good as our NHS. melissam and Drowlord (can't believe I'm agreeing with him!) have given the answers that I thought nearest the mark.

Of course I know nothing much about Obamacare to be fair.
Oct 21, 2013
I'm curious about the cost of not covering the uninsured in the US. (It's not $0, as many seem to assume.)

Everyone agrees that the current Health Care system is broken in this country. What are the other options? At least Obamacare has been tested on a small scale in Massachusetts. Are there any other working solutions?

Oct 21, 2013

As many of you know, I don't read the posts here prior to writing my own. So I just read fawn's post.

My wife's experience differs from hers. She has been trying to get on the California exchange site since it opened. No luck. She sent them an email trying to get some help. It hasn't been answered. She's still trying.

What we don't know is how much the state exchanges cost to set up. As many of you know, California is a liberal state that is hugely in debt. Our answer to our debt? Start a bullet-train project guaranteed to bankrupt us. I can't imagine they will do much better with health care.
Oct 21, 2013
There you go again.

You have a tendency to throw in little gems of erroneous assumptions when you write these posts. This post's last sentence ("And keep in mind that you know as little about Obamacare as I do.") is one of your most egregious examples.

You have no idea how much I know about Obamacare. Nor do I know how much you know about it. But there is no doubt that one of us knows less than the other. As you well know, but which you would never admit. But here's one question: have you read the bill? I have. Actually, there are two statutes totaling 961 pages. Did you know that?

Moving on: with all due respect, you are politically naive. Focusing on Obamacare's effects on the economy and jobs and quality of medical care are only a part of what should concern you. The larger concern is its effect on our national debt. We're at $17 trillion and rising, with the president and the Democrats pushing to increase the debt limit without any reduction in spending. And that doesn't even start to take into account the roughly $80 trillion in unfunded liabilities, which the end game of Obamacare, single-payer, will certainly increase.

Fortunately, the Sequester did reduce the baseline (if you don't understand the baseline budgeting concept used by the federal government, you had better educate yourself quickly), but not by very much. That's why the Democrats are livid that the one thing the Republicans got out of the recent government shutdown is that the Sequester remained intact. Again, if you don't understand all this, you should come up to speed on it immediately.

You, Scott, are both a techie and an economist. Somehow, though, you overlook the evidence that is right before you. The federal government spent $648 million and three years in producing the Obamacare web site. The people running the program were bureaucrats who understood neither technology nor economics. And it is a disaster. That should tell you something about government efficiency and their ability to run our health care system, but it didn't even get a line in your post. Why not?

Do you think any business that was looking to succeed would have had to spend that much, take that long, and then get the results the government got? Not even a Lilliputian chance of that. So why, then, does the government get to continue to fail expensively on our money and keep bulldozing forward off the cliff? Without so much as a peep from you?

You seem to treat the entire direction of our country and our government as though it is an academic exercise that you can sit back and watch without really being involved. Scott, you are involved, and your involvement is rapidly moving from the chicken to the pig in the proverbial ham-and-egg breakfast.

Obamacare is not about health insurance. It is not about health care. It is about furthering the power of government and its control over our daily lives. To look at it any other way is both naive and frightening, because it means you don't really comprehend what's going on.

Obamacare is just the latest example of government inefficiency, waste and fraud, being propped up by borrowing from China and the printing of money by the federal reserve. No matter how bad Obamacare is, no matter how wasteful and horrifying the results, the present government will keep propping it up with your children and grandchildren's as yet unearned money. That's not OK with me. Is it with you?

Every citizen of this country needs to get involved. Scott seems to think the train wreck he's watching doesn't really involve him. How about you?
+7 Rank Up Rank Down
Oct 21, 2013
The slow moving disaster is the health care system. The U.S spends twice as much per capita compared to other modern countries yet not everyone is covered by insurance and the overall health outcomes are not even close to the top countries.

The ACA is a step in the right direction by getting everyone into the insurance pool but there is a long ways to go for cost control.
+2 Rank Up Rank Down
Oct 21, 2013

I'm going totally off topic, but I can't help but follow...

You wrote:
" It is obvious (at least to me) at some point people will quit loaning the government money. I guess it is a forgone conclusion that the government will operate the printing presses full time printing more and more increasingly worthless money. I differ with Reid and Pelosi on matters of policy, but I still find it hard to believe that they are the chief lemmings leading America off the cliff without a second thought. The responsible thing for them to do would be to advocate for sky high taxes if they want lavish government spending, but they don't seem to have the character for that. "

It's a matter of confidence. People point to Zimbabwe and the Weimar Republic as examples of hyperinflation. In those examples, no one had confidence in those countries, so who in their right mind would buy their debt? So, they had no choice but to print. But those were smaller economies. In the case of the U.S. we obviously have a huge debt market. That doesn't happen unless there is confidence. And no where else is there a large enough debt market for large institutions and sovereign nations to park their money. So guess what, we will never get to the point where no one buys our debt. Society will crash and burn long before that happens.

Currently, we are printing money like crazy. But not to meet obligations directly. Why do you think we rasied the debt ceiling? We are printing like crazy for QE. We are printing money so that we can use it to buy more of our own debt and the toxic assets of large commercial banks. At this point, it would be cheaper for us to print money and pay with it directly rather than borrow. At least then, there would be no additional interest payments on the new money. Right now, all money that is created is really debt. It's just insane.

Lastly, you will pray for money printing because that implies the government cares about meeting obligations with as little pain to you as possible. The government does not see its spending as the problem, only a lack of sufficient revenue as the problem. So, government is ramping up it's hunt for money. So, your last statement makes no sense. How much better is your life going to be when the government takes more of your hard-earned money?
Oct 21, 2013
[ As far as we in the UK can see, Obamacare is similar to our National Health Service where medical care is free (funded by taxes). This was massively opposed by doctors when it was introduced but is now universally loved although beset by recent huge problems due to government interference and management stupidity. ]

No offense, but from these two sentences, NHS sounds like a classic government clusterf*ck. Sure, everybody loves it -- who doesn't love getting stuff for free? -- but that doesn't mean it *works*.

Normal businesses have to balance two variables: the cost of doing business, and the amount they make. They have an incentive to make the first as small as possible, because if their costs expand too much, it doesn't matter how much money they bring in. The largest business in the world can still go bankrupt if it doesn't control its costs.

A government run business, though, CAN'T fail in the normal sense of the word. Its continued existence is predicated solely on the second variable: the larger it is, the more likely it will continue to be funded, because size equals impact equals votes. Whether or not it is actually profitable is irrelevant, which means there is NO incentive for its operators to make it more efficient. Actually, it is worse than that: being efficient means focusing on the biggest opportunities, which in turn means deliberately limiting scope in order to maximize the profit/cost ratio. But a government-run business doesn't care about that ratio, because it doesn't have to care about cost, only size. Thus, its operators actually have a perverse incentive to NOT be efficient.

The result is entirely, utterly predictable: an inefficiently run business that nevertheless continues to grow and grow while losing money. Real business can run this way for a while in order to achieve market share, but at some point they have to rein in the spending. Government-run businesses, though, can operate like this ad infinitum. They almost HAVE to.

Which brings us to Obamacare. While I can see the validity of Scott's theory, I don't think it applies here. The reason that slow moving disasters eventually are usually avoided is that as the problem looms, every individual affected has more and more reason to take action; eventually, a tipping point is reached, action is taken, and the crisis is averted. In this case, though, I don't think that tipping point will ever be reached. BY DESIGN, the benefits are concentrated but the costs are diffuse, meaning that those who benefit will always have a bigger stake in keeping it around than those who don't benefit have in killing it. Toss in most people's remarkable capacity for self-delusion, and it is easy to see nothing ever happening until it is too late.

To be clear, I don't think Obamacare by itself is the problem. What it is adding to government spending on health care is actually relatively small. Health care spending, however, is already by far the largest part of the federal budget, costing us more than $1T each year (defense, that old bugaboo, is a distant second at around $800B), with no slowdown of its growth in sight. THAT'S the real problem. If you want to see the genesis of our $17T debt, look over the last 50 years of government spending; the growth in health care spending has directly caused most of it. Obamacare is just the icing on the cake.

To be fair, government health care has done a lot of good for a lot of people, which I'm all in favor of. But isn't it possible to favor the outcome while decrying the method? People opposed to government health care are usually portrayed as unfeeling monsters who don't care if people get sick and die, which is ridiculous. I want everyone to have a full and happy life. But I also believe that there is a way to achieve that without bankrupting our country in the process, which is what is happening.
Oct 20, 2013
>But interestingly, I'll bet there will someday be an objective way to look back and say, "That worked," or "What the $#%@ were we thinking?"

Based on what? Is there agreement about the causes of the Great Depression or the efficacy of the New Deal? What about whether creating the Federal Reserve was a good idea?
Oct 20, 2013
The ACA regulations are 30,000 pages. Who understands it well enough to place a bet?
+19 Rank Up Rank Down
Oct 19, 2013
Obamacare is an attempt to fill the gaps in the existing public and private health insurance system. These gaps are all over the place--people not covered by either public or private number about 45 million at any given time, 80 million in any given year, etc.

That 45 million number is just the people with NO coverage (a simple problem, although a costly one), not those with crappy, incomplete or ridiculously expensive coverage. The US system is the costliest in the world built over one of the worst abyssmal pits of Hell.

Naturally, when you go around trying to patch leaks in a boat that barely floats, you have complexity. What you need is a new boat. And you have to build it around the old boat because people are living in it with no place to go.

Nobody dares to take on the insurance industry.

Nobody dares to take on the medical and pharmaceutical industries.

Nobody dares to take on the medical professionals and their unions (such as the AMA, the APA, etc.)

I just pointed out that the problem is three or four of the richest and most powerful special interests in the world. The richest industry, the richest profession, and the also-rans.

To paraphrase a book title by a certain industrious business cartoonist, POLITICS MEAN THAT YOU CAN'T PICK THE SIDE THAT'S RIGHT.
+8 Rank Up Rank Down
Oct 19, 2013
Havong been involved in (harmless) bets with co workers, I still have a some questions:
1) What's the success criterion? It should be binary and, hopefully, self evident.
2) What about republicans modifying it to the point of pointlessness next time they get the chance?
3) Who adjudicates the bet? A tea party boy and a democrat may have different opinions about whether it qualifies as "success". There are still holocaust deniers out there, see?
Oct 19, 2013
In response to mildcigar_2001, one might almost call for an amendment to the Adams Rule of Slow-Moving Disasters, stating that people will fix any problem given enough advance notice, unless that disaster is in the hands of the American government.
Get the new Dilbert app!
Old Dilbert Blog